Abstract

Bulimia nervosa (BN) is a highly researched eating disorder, yet real world recovery rates remain poor and incidence continues to rise. This study provides a focused exploration of the father-daughter relationship where BN emerges, in order to explore this relationship’s significance to the aetiology of BN and to BN’s resistance to CBT-based treatment. A hermeneutic phenomenological study of six women in recovery from BN was undertaken. Unstructured interviewing gathered detail-rich information, which was interpreted using the hermeneutic phenomenological method of multiple-level repeated readings, thematic comparisons and contextualisation. Findings were confirmed and validated using the hermeneutic circle and peer consultation. Fathers of daughters with BN were found to be a source of fear, control, abuse, emotional and physical avoidance and gender diminishment. This was a key source of complex traumatic experience in the family setting, with BN emerging in daughters to provide distraction and soothing. Furthermore, BN acts as a survival mechanism from early childhood and is a logical embodied response to the lived experience of complex trauma. The presence of trauma in the aetiology of BN, makes sense of why cognitive-based therapeutic protocols provide for limited treatment success. The research suggests greater potential lies in adopting the individualised, multi-modal complex trauma treatment model for BN, as this more appropriately addresses outcomes of relationship trauma.

摘要

神经性贪食症 (BN) 是一种经过高度研究的饮食失调症，但现实世界的康复率仍然很低，发病率继续上升。本研究重点探讨了 BN 出现的父女关系，以探讨这种关系对 BN 的病因和 BN 对基于 CBT 的治疗的抵抗力的意义。对六名从 BN 康复中的女性进行了解释学现象学研究。非结构化访谈收集了细节丰富的信息，这些信息使用多层次重复阅读、主题比较和情境化的解释现象学方法进行解释。研究结果通过解释学循环和同行咨询得到确认和验证。BN 女儿的父亲被发现是恐惧、控制、虐待、情绪和身体上的回避和性别减少。这是家庭环境中复杂创伤经历的关键来源，BN 出现在女儿身上以提供分心和舒缓。此外，BN 作为儿童早期的生存机制，是对复杂创伤的生活经历的逻辑体现的反应。BN 的病因中存在创伤，这解释了为什么基于认知的治疗方案提供有限的治疗成功。研究表明，更大的潜力在于为 BN 采用个性化的、多模式的复杂创伤治疗模型，因为这更恰当地解决了关系创伤的结果。此外，BN 作为儿童早期的生存机制，是对复杂创伤的生活经历的逻辑体现的反应。BN 的病因中存在创伤，这解释了为什么基于认知的治疗方案提供有限的治疗成功。研究表明，更大的潜力在于为 BN 采用个性化的、多模式的复杂创伤治疗模型，因为这更恰当地解决了关系创伤的结果。此外，BN 作为儿童早期的生存机制，是对复杂创伤的生活经历的逻辑体现的反应。BN 的病因中存在创伤，这解释了为什么基于认知的治疗方案提供有限的治疗成功。研究表明，更大的潜力在于为 BN 采用个性化的、多模式的复杂创伤治疗模型，因为这更恰当地解决了关系创伤的结果。